We’ve long debated the significance of uncorrected hyperopia. Many pediatric ophthalmologists and some pediatric optometrists feel that hyperopia needn’t be corrected unless a child is either complaining of headaches or if it is causing accommodative esotropia. As reviewed by Donahue, only 33% of optometrists and 5% of ophthalmologists would prescribe glasses for a 6 year-old child having 3 to 4 diopters of hyperopia in both eyes. Prior studies have shown that lower amounts of uncompensated farsightedness can interfere with literacy skills in older children, but this is the first multi center controlled study to look at the preschool population. We can quibble over how much hyperopia is significant, and the fact that this study only looked at hyperopia under cycloplegia. After all, some of these preschoolers in the moderate range under cycloplegia will have lower amounts without the drops in place. That’s a discussion for another day.
The article based on the ARVO presentation by the VIP-HIP (Vision in Preschoolers/Hyperopia in Preschoolers) collaborative is now in press in Ophthalmology, the journal of the American Academy of Ophthalmology. The test used in the study to probe the connection between uncorrected hyperopia and litracy is the TOPEL.
What’s the bottom line? This now clearly turns the tables on the entire subject of Learning-Based Vision Problems. Vision as an essential component of reading readiness is up for grabs. Now included in the conversation about literacy has to be the impact of some relevant amount of uncompensated hyperopia. That also opens up the door for more serious discussion about accommodative lag, and those children who didn’t read the book well enough to know that they can have decent distance acuity, but not sustain accommodation well enough to maintain focus at near with any reasonable efficiency. No longer can these issues be dismissed by those who claim that optometrists “over prescribe glasses”. The burden of proof has just shifted to practitioners who under-prescribe. And by that I don’t mean cut the power of the Rx; I mean withholding a prescription altogether. The bottom line just got a whole lot more interesting!